レンバチニブ及び放射線治療後の再肝切除による集学的治療が奏功した門脈腫瘍栓を伴う早期再発肝細胞癌の1例
50代男性．未治療B型慢性肝炎の既往があり，人間ドックで肝腫瘤を指摘され，精査の結果肝細胞癌（Hepatocellular carcinoma：HCC）の診断に至った．病変はS8に2カ所あり，開腹肝前区域切除を行い，病理組織診断でvp2を認めた．術後2カ月で施行した造影CT検査で門脈左枝に門脈腫瘍栓（Portal vein tumor thrombosis：PVTT）を認めた．術後早期再発したPVTTであり再肝切除後の再発のリスクが高いと考え，観察期間を設けるためLenvatinib（LEN）投与を開始した．PVTTは放射線定位照射したが，術後9カ月に肝右葉微小転移が指摘された．LEN投与下に...
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| Published in | 肝臓 Vol. 64; no. 12; pp. 641 - 648 |
|---|---|
| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本肝臓学会
01.12.2023
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0451-4203 1881-3593 |
| DOI | 10.2957/kanzo.64.641 |
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| Abstract | 50代男性．未治療B型慢性肝炎の既往があり，人間ドックで肝腫瘤を指摘され，精査の結果肝細胞癌（Hepatocellular carcinoma：HCC）の診断に至った．病変はS8に2カ所あり，開腹肝前区域切除を行い，病理組織診断でvp2を認めた．術後2カ月で施行した造影CT検査で門脈左枝に門脈腫瘍栓（Portal vein tumor thrombosis：PVTT）を認めた．術後早期再発したPVTTであり再肝切除後の再発のリスクが高いと考え，観察期間を設けるためLenvatinib（LEN）投与を開始した．PVTTは放射線定位照射したが，術後9カ月に肝右葉微小転移が指摘された．LEN投与下にPVTTと微小転移は増悪を認めず，AFP値が正常化したため，再発後11カ月で再肝切除を行った．その後，微小転移に対してサイバーナイフを施行し完全寛解した．現在，初回術後43カ月無再発生存中である． |
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| AbstractList | 50代男性．未治療B型慢性肝炎の既往があり，人間ドックで肝腫瘤を指摘され，精査の結果肝細胞癌（Hepatocellular carcinoma：HCC）の診断に至った．病変はS8に2カ所あり，開腹肝前区域切除を行い，病理組織診断でvp2を認めた．術後2カ月で施行した造影CT検査で門脈左枝に門脈腫瘍栓（Portal vein tumor thrombosis：PVTT）を認めた．術後早期再発したPVTTであり再肝切除後の再発のリスクが高いと考え，観察期間を設けるためLenvatinib（LEN）投与を開始した．PVTTは放射線定位照射したが，術後9カ月に肝右葉微小転移が指摘された．LEN投与下にPVTTと微小転移は増悪を認めず，AFP値が正常化したため，再発後11カ月で再肝切除を行った．その後，微小転移に対してサイバーナイフを施行し完全寛解した．現在，初回術後43カ月無再発生存中である． |
| Author | 西山, 亮 木村, 大輝 神, 雄太 下河原, 達也 江川, 智久 今井, 俊一 小金井, 雄太 山田, 暢 青山, 純也 中野, 容 |
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| References | 17) Kim N, Cheng J, Jung I, et al. Stereotactic body radiation therapy vs. radiofrequency ablation in Asian patients with hepatocellular carcinoma. J Hepatol 2020; 73: 121-129 20) Li N, Feng S, Xue J, et al. Hepatocellular carcinoma with main portal vein tumor thrombus: a comparative study comparing hepatectomy with or without neoadjuvant radiotherapy. HPB (Oxford) 2016; 18: 549-556 12) Weiner AA, Olsen L, Ma D, et al. Stereotactic body radiotherapy for primary hepatic malignancies - Report of a phase I/II institutional study. Radiother Oncol 2016; 121: 79-85 4) Matsuki R, Kawai K, Suzuki Y, et al. Pathological Complete Response in Conversion Hepatectomy Induced by Lenvatinib for Advanced Hepatocellular Carcinoma. Liver Cancer 2020; 9: 358-360 21) Ohya Y, Hayashida S, Tsuji A, et al. Conversion hepatectomy for advanced hepatocellular carcinoma after right portal vein transection and lenvatinib therapy. Surg Case Rep 2020; 6: 318 10) Takeda A, Sanuki N, Tsurugai Y, et al. Phase 2 study of stereotactic body radiotherapy and optional transarterial chemoembolization for solitary hepatocellular carcinoma not amenable to resection and radiofrequency ablation. Cancer 2016; 122: 2041-2049 13) Kang JK, Kim MS, Cho CK, et al. Stereotactic body radiation therapy for inoperable hepatocellular carcinoma as a local salvage treatment after incomplete transarterial chemoembolization. Cancer 2012; 118: 5421-5431 1) Llovet JM, Bustamante J, Castells A, et al. Natural history of untreated nonsurgical hepatocellular carcinoma: rationale for the design and evaluation of therapeutic trials. Hepatology 1999; 29: 62-67 9) 加藤 透, 青笹季文, 野呂拓史, 他. 放射線治療を含む術前治療後に切除した門脈腫瘍栓合併肝細胞癌 (18 cm) の1例. 肝臓 2017; 58: 18-37 23) Takahashi K, Kim J, Takahashi A, et al. Conversion hepatectomy for hepatocellular carcinoma with main portal vein tumour thrombus after lenvatinib treatment: A case report. World J Hepatol 2021; 13: 384-392 15) Lasley FD, Mannia EM, Johnson CS, et al. Treatment variables related to liver toxicity in patients with hepatocellular carcinoma, Child-Pugh class A and B enrolled in a phase 1-2 trial of stereotactic body radiation therapy. Pract Radiat Oncol 2015; 5: 443-449 24) Matsuki R, Okano N, Arai T, et al. Regression of Tumor Thrombus in the Suprahepatic Vena Cava of Hepatocellular Carcinoma and Conversion Hepatectomy Induced by Lenvatinib. Liver Cancer 2022; 11: 278-280 3) Sato N, Beppu T, Kinoshita K, et al. Conversion Hepatectomy for Huge Hepatocellular Carcinoma With Arterioportal Shunt After Chemoembolization and Lenvatinib Therapy. Anticancer Research 2019; 39: 5695-5701 18) Chen J, Xiong P, Nie M, et al. The combination treatment strategy of lenvatinib for hepatocellular carcinoma: a real-world study. J CancerRes Clin Oncol 2023; 149: 2491-2500 7) Tada M, Ichida A, Arita J, et al. Multicenter prospective study to evaluate the efficacy of lenvatinib to achieve conversion surgery for initially unresectable hepatocellular carcinoma: LENS-HCC trial. Journal of Clinical Oncology 2022; 40: 458-458 2) 日本肝臓学会編, 「「肝癌診療ガイドライン」2021年版」金原出版, 東京, 2022 6) Kudo M, Finn RS, Qin S, et al. Lenvatinib versus sorafenib in first-line treatment of patients with unresectable hepatocellular carcinoma: a randomised phase 3 non-inferiority trial. Lancet 2018; 391: 1163-1173 19) Yan WT, Li C, Yao LQ, et al. Predictors and long-term prognosis of early and late recurrence for patients undergoing hepatic resection of hepatocellular carcinoma: a large-scale multicenter study. HepatoBiliary Surg Nutr 2023; 12: 155-168 25) Naganuma A, Suzuki Y, Hoshino T, et al. A case of conversion hepatectomy for huge ruptured hepatocellular carcinoma after transarterial embolization and lenvatinib therapy. Clin J Gastroenterol 2022; 15: 177-184 11) Jang WI, Bae SH, Kim MS, et al. A phase 2 multicenter study of stereotactic body radiotherapy for hepatocellular carcinoma: Safety and efficacy. Cancer 2020; 126: 363-372 5) Tetsu T, Sato Y, Tanaka H. Conversion therapy for unresectable hepatocellular carcinoma after lenvatinib Three case reports. Medicine (Baltimore) 2020; 99: 1-7 14) Bujold A, Massey CA, Kim JJ, et al. Sequential phase I and II trials of stereotactic body radiotherapy for locally advanced hepatocellular carcinoma. J Clin Oncol 2013; 31: 1631-1639 16) Hara K, Takeda A, Tsurugi Y, et al. Radiotherapy for hepatocellular carcinoma results in comparable survival to radiofrequency ablation: a prospensity score analysis. Hepatology 2019; 69: 2533-2545 8) Yamashita T, Kudo M, Ikeda K, et al. REFLECT-a phase 3 trial comparing efficacy and safety of lenvatinib to sorafenib for the treatment of unresectable hepatocellular carcinoma: an analysis of Japanese subset. J Gastroenterol 2020; 55: 113-122 22) Endo K, Kuroda H, Abe T, et al. Two hepatectomy cases for initially unresectable hepatocellular carcinoma after achieving a radiological complete response to sequential therapy with lenvatinib and transcatheter arterial chemoembolization. Hepatol Res 2021; 51: 1082-1086 |
| References_xml | – reference: 4) Matsuki R, Kawai K, Suzuki Y, et al. Pathological Complete Response in Conversion Hepatectomy Induced by Lenvatinib for Advanced Hepatocellular Carcinoma. Liver Cancer 2020; 9: 358-360 – reference: 6) Kudo M, Finn RS, Qin S, et al. Lenvatinib versus sorafenib in first-line treatment of patients with unresectable hepatocellular carcinoma: a randomised phase 3 non-inferiority trial. Lancet 2018; 391: 1163-1173 – reference: 16) Hara K, Takeda A, Tsurugi Y, et al. Radiotherapy for hepatocellular carcinoma results in comparable survival to radiofrequency ablation: a prospensity score analysis. Hepatology 2019; 69: 2533-2545 – reference: 2) 日本肝臓学会編, 「「肝癌診療ガイドライン」2021年版」金原出版, 東京, 2022 – reference: 7) Tada M, Ichida A, Arita J, et al. Multicenter prospective study to evaluate the efficacy of lenvatinib to achieve conversion surgery for initially unresectable hepatocellular carcinoma: LENS-HCC trial. Journal of Clinical Oncology 2022; 40: 458-458 – reference: 15) Lasley FD, Mannia EM, Johnson CS, et al. Treatment variables related to liver toxicity in patients with hepatocellular carcinoma, Child-Pugh class A and B enrolled in a phase 1-2 trial of stereotactic body radiation therapy. Pract Radiat Oncol 2015; 5: 443-449 – reference: 22) Endo K, Kuroda H, Abe T, et al. Two hepatectomy cases for initially unresectable hepatocellular carcinoma after achieving a radiological complete response to sequential therapy with lenvatinib and transcatheter arterial chemoembolization. Hepatol Res 2021; 51: 1082-1086 – reference: 14) Bujold A, Massey CA, Kim JJ, et al. Sequential phase I and II trials of stereotactic body radiotherapy for locally advanced hepatocellular carcinoma. J Clin Oncol 2013; 31: 1631-1639 – reference: 12) Weiner AA, Olsen L, Ma D, et al. Stereotactic body radiotherapy for primary hepatic malignancies - Report of a phase I/II institutional study. Radiother Oncol 2016; 121: 79-85 – reference: 3) Sato N, Beppu T, Kinoshita K, et al. Conversion Hepatectomy for Huge Hepatocellular Carcinoma With Arterioportal Shunt After Chemoembolization and Lenvatinib Therapy. Anticancer Research 2019; 39: 5695-5701 – reference: 9) 加藤 透, 青笹季文, 野呂拓史, 他. 放射線治療を含む術前治療後に切除した門脈腫瘍栓合併肝細胞癌 (18 cm) の1例. 肝臓 2017; 58: 18-37 – reference: 11) Jang WI, Bae SH, Kim MS, et al. A phase 2 multicenter study of stereotactic body radiotherapy for hepatocellular carcinoma: Safety and efficacy. Cancer 2020; 126: 363-372 – reference: 8) Yamashita T, Kudo M, Ikeda K, et al. REFLECT-a phase 3 trial comparing efficacy and safety of lenvatinib to sorafenib for the treatment of unresectable hepatocellular carcinoma: an analysis of Japanese subset. J Gastroenterol 2020; 55: 113-122 – reference: 25) Naganuma A, Suzuki Y, Hoshino T, et al. A case of conversion hepatectomy for huge ruptured hepatocellular carcinoma after transarterial embolization and lenvatinib therapy. Clin J Gastroenterol 2022; 15: 177-184 – reference: 5) Tetsu T, Sato Y, Tanaka H. Conversion therapy for unresectable hepatocellular carcinoma after lenvatinib Three case reports. Medicine (Baltimore) 2020; 99: 1-7 – reference: 23) Takahashi K, Kim J, Takahashi A, et al. Conversion hepatectomy for hepatocellular carcinoma with main portal vein tumour thrombus after lenvatinib treatment: A case report. World J Hepatol 2021; 13: 384-392 – reference: 17) Kim N, Cheng J, Jung I, et al. Stereotactic body radiation therapy vs. radiofrequency ablation in Asian patients with hepatocellular carcinoma. J Hepatol 2020; 73: 121-129 – reference: 20) Li N, Feng S, Xue J, et al. Hepatocellular carcinoma with main portal vein tumor thrombus: a comparative study comparing hepatectomy with or without neoadjuvant radiotherapy. HPB (Oxford) 2016; 18: 549-556 – reference: 1) Llovet JM, Bustamante J, Castells A, et al. Natural history of untreated nonsurgical hepatocellular carcinoma: rationale for the design and evaluation of therapeutic trials. Hepatology 1999; 29: 62-67 – reference: 19) Yan WT, Li C, Yao LQ, et al. Predictors and long-term prognosis of early and late recurrence for patients undergoing hepatic resection of hepatocellular carcinoma: a large-scale multicenter study. HepatoBiliary Surg Nutr 2023; 12: 155-168 – reference: 10) Takeda A, Sanuki N, Tsurugai Y, et al. Phase 2 study of stereotactic body radiotherapy and optional transarterial chemoembolization for solitary hepatocellular carcinoma not amenable to resection and radiofrequency ablation. Cancer 2016; 122: 2041-2049 – reference: 21) Ohya Y, Hayashida S, Tsuji A, et al. Conversion hepatectomy for advanced hepatocellular carcinoma after right portal vein transection and lenvatinib therapy. Surg Case Rep 2020; 6: 318 – reference: 18) Chen J, Xiong P, Nie M, et al. The combination treatment strategy of lenvatinib for hepatocellular carcinoma: a real-world study. J CancerRes Clin Oncol 2023; 149: 2491-2500 – reference: 24) Matsuki R, Okano N, Arai T, et al. Regression of Tumor Thrombus in the Suprahepatic Vena Cava of Hepatocellular Carcinoma and Conversion Hepatectomy Induced by Lenvatinib. Liver Cancer 2022; 11: 278-280 – reference: 13) Kang JK, Kim MS, Cho CK, et al. Stereotactic body radiation therapy for inoperable hepatocellular carcinoma as a local salvage treatment after incomplete transarterial chemoembolization. Cancer 2012; 118: 5421-5431 |
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| Snippet | 50代男性．未治療B型慢性肝炎の既往があり，人間ドックで肝腫瘤を指摘され，精査の結果肝細胞癌（Hepatocellular carcinoma：HCC）の診断に至った．病変はS8に2カ所あり，開腹肝前区域切除を行い，病理組織診断でvp2を認めた．術後2カ月で施行した造影CT検査で門脈左枝に門脈腫瘍栓（Portal... |
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| SubjectTerms | サイバーナイフ レンバチニブ 放射線治療 肝細胞癌 集学的治療 |
| Title | レンバチニブ及び放射線治療後の再肝切除による集学的治療が奏功した門脈腫瘍栓を伴う早期再発肝細胞癌の1例 |
| URI | https://www.jstage.jst.go.jp/article/kanzo/64/12/64_641/_article/-char/ja |
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